Heart, Lung and Circulation最新文献

Background: Localisation of outflow tract (OT) premature ventricular complex (PVC) sites is guided by unipolar and bipolar local activation time (LAT). However, LAT-based localisation can be inaccurate if the site is intramural or distant. Deep foci produce rapid conduction velocity (CV) if the wavefront is tangential to the surface.

Aim: We evaluated whether supraphysiological CV, referred to as surface isochronal apparent dispersion (IAD) mapping, can be used to accurately differentiate right and left ventricular OT PVC origin, guiding the successful site for OT PVC ablation.

Method: Left ventricular OT mapping was performed if right ventricular OT mapping demonstrated a bipolar electrogram (EGM) <20 ms. The earliest EGMs underwent analysis of the following: first deflection bipolar EGM (bipolar_earliest) to QRS, bipolar_earliest to first deflection unipolar EGM (unipolar_earliest), bipolar_earliest to unipolar -dV/dT_max, unipolar -dV/dT_max to QRS, number of early LAT breakouts, and the surface area of the earliest isochronal breakout. Polynomial CV was calculated using a custom algorithm in MATLAB using cut-offs between 1 and 100,000 cm/s and used to create IAD, referred to as apparent dispersion index. The accuracy of IAD to distinguish between successful and unsuccessful OT sites was assessed and compared with conventional EGM indices.

Results: Bipolar_earliest to QRS (28.5±7.3 ms vs 17.8±5.7 ms; p<0.05) is superior to unipolar -dV/dt_max to QRS (0.4±26.4 ms vs -6.4±13.4 ms; p=0.25) in differentiating successful and unsuccessful OT PVC sites. An early isochronal breakout area of less than 1 cm² and less than two breakouts indicates a successful side (both p<0.05). Bipolar_earliest to unipolar -dV/dT_max and to unipolar_earliest were not predictive (28.1±27.7 vs 24.2±13.3 ms; p=0.97 and 6.4±7.3 vs 6.4±5.8 ms; p=0.8, respectively). IAD appears to differentiate between successful and unsuccessful sites using an apparent dispersion index cut-off of 20,000 cm/s, with an accuracy of 93.8% and area under the receiver operator characteristic of 0.95.

Conclusions: IAD is a realistic two-dimensional interpretation of the three-dimensional activation mapping surface that may be associated with OT origins to guide a successful side of catheter ablation.

Aim: Regulatory T cells (Tregs) play a crucial role in the development and progression of atherosclerosis. However, the specific association between Treg immune traits and atherosclerosis and related cardiovascular diseases remains unclear, impeding their potential for clinical therapeutic application.

Method: Fifty-eight Treg-related immune traits were obtained from the latest summary level genome-wide association study, which included 3,757 individuals from Sardinia. Additionally, three atherosclerosis subsets and three atherosclerosis-related cardiovascular diseases were obtained from the FinnGen database. Subsequently, comprehensive bidirectional Mendelian randomisation (MR) analysis was performed using inverse-variance weighting as the primary method. Sensitivity analyses were performed to verify the robustness, heterogeneity, and horizontal pleiotropy of the results. Co-localisation analysis was performed to detect whether the exposure and outcome shared causal variants.

Results: Four significant Treg-related immune traits linked to a lower risk of three cardiovascular diseases were identified in the forward MR analysis. Specifically, two traits were identified for cerebral atherosclerosis: CD39⁺ activated CD4⁺ Treg absolute count (OR 0.70, 95% CI 0.57-0.87, p_FDR=0.040 [false discovery rate]) and activated CD4 Tregs % CD4⁺ T cells (OR 0.64, 95% CI 0.48-0.84, p_FDR=0.040). In addition, CD28 on secreting CD4 Tregs (OR 0.95, 95% CI 0.93-0.98, p_FDR=0.014) was detected for other atherosclerosis. In ischaemic heart disease, CD28 on activated CD4 Tregs was protective (OR 0.96, 95% CI 0.95-0.98, p_FDR=0.020). An increased intensity of CD3 and CD4 was observed in reverse MR after the occurrence of stroke and ischaemic heart disease, respectively, whereas a lower number and proportion of CD39⁺-secreting CD4 Tregs were noted after ischaemic heart disease. Co-localisation analysis indicated that there were no shared causal variants among significant associations in forward MR.

Conclusion: This study revealed a potential causal relationship between Tregs and atherosclerosis and related cardiovascular diseases, providing a plausible hypothesis for future clinical and basic research.

Background & aim: Sternotomy remains a commonly used technique to access the heart for cardiac surgery worldwide. To date, there is no clear consensus on the single superior sternal closure technique. Patient-specific factors such as osteoporosis, diabetes, old age, body habitus influence a surgeon's choice in this matter as do techniques commonly used during the training period and used in the current workplace. The goal is to achieve good bony union and prevent deep sternal wound infection and mediastinitis. Utilising stainless steel wires to repair the sternum is still the most prevalent technique. Numerous studies demonstrate no superiority with infection prevention or sternal dehiscence when comparing simple interrupted wiring techniques to more specialised techniques such as longitudinal sternal wiring or figure-of-eight wiring. There may be a reduction in wound complications with sternal plating compared to wiring. This is especially true for patients with one or more risk factors, who may benefit from sternal reinforcement with specialised or advanced wiring or additional plating. The aim of this study was to explore the optimal sternal closure technique post-adult cardiac surgery.

Method: A retrospective study of all patients undergoing cardiac surgery with the aid of sternotomy in the year 2021 was conducted at a quaternary hospital. Results were analysed following sternal re-approximation using wires, cables or plating in the short term (<30 days) and at 1-year follow up. The primary outcome measure was 1 year free from surgical reintervention with secondary outcome measures including rates of superficial infection, wound dehiscence, deep sternal infection and mediastinitis as well as the need for further active management or surgical reintervention.

Results: This study demonstrated superior outcomes following wire closure versus cable closure including a decreased need for surgical reintervention, intravenous antibiotics or readmission with a trend towards reduced sternal non-union. The results were similar among patients who had wires as opposed to plating. It was also observed that risk factors including diabetes, emergency surgery and the need to return to theatre increased the patient's risk for short-term postoperative sternal complications including superficial and deep infections, wound dehiscence and sternal non-union.

Conclusions: This study would support the use of wires as the superior sternal repair technique when taking into account the lower cost profile of wires vs sternal plating with similar sternal outcomes. There was an increased need for surgical reintervention, readmission and intravenous antibiotics following the use of cables for sternal closure.

Background: Research suggests that although men have a higher cardiovascular disease (CVD) rate, women with CVD are more likely to experience a poorer prognosis, possibly owing to incorrect diagnosis and poorer treatment. A question not yet addressed is whether some of this inequality could be due to sex bias when selecting patients for operation.

Method: The participants were from the Scottish Heart Health Extended Cohort who had been admitted to hospital with a cardiovascular diagnosis over the study period. Participants were recruited between 1984 and 1995 and followed up until 2017. Using propensity score nearest neighbour matching, women were matched 1:1 with men on year of birth, year and reason of admission, smoking status, previous cardiovascular disease (CVD), and family history of CVD. Conditional logistic regression was used to estimate odds ratios and 95% confidence intervals.

Results: After matching, 19,960 admissions (50% women) to hospital for cardiac reasons were available for analysis. Women were less likely to have a cardiac intervention, that is (endovascular or surgical revascularisation), after admission for any cardiovascular reason (6.83% of men, 2.84% of women; odds ratio [OR] 0.56; 95% confidence intervals [CIs] 0.42-0.75), or admission for cardiac ischaemia only (11.07% of men; 6.09% of women; OR 0.52; 95% CI 0.37-0.74). The sex difference was more pronounced in the early part of the study but persisted in the latter phase.

Conclusions: In this matched study of cardiovascular admissions to Scottish hospitals, women were less likely to be recommended for a surgical procedure, even when matched with men for common CVD risk factors.

Background & aim: The definition and clinical relevance of percutaneous coronary intervention (PCI)-related myocardial infarction (MI) has been a topic of significant debate and controversy. It has particularly garnered widespread attention recently due to a contemporary trend of including it as a component of primary end points in major trials. The study aimed to assess the clinical relevance of PCI-related MI (PMI) according to the Fourth Universal Definition of MI using a high-sensitivity troponin (hs-Tn) assay in a real-world setting.

Methods: This was a single centre, retrospective registry analysis of consecutive patients who underwent elective PCI for stable ischaemic heart disease between January 2014 to December 2018. The primary end point was major adverse cardiovascular events (MACEs)-the composite of death, spontaneous MI, stent thrombosis and the need for repeat revascularisation within 12 months from the index procedure.

Results: We treated 858 patients with a mean age of 67.6 years and 78.3% were men. The incidence of PMI in our cohort was 12.8%. On univariable analysis, contrast volume >150 mL, prior coronary artery bypass graft, final thrombolysis in MI flow 0-2, total stent length and stent length >20 mm were significantly associated with increased risk of PMI. There were 46 (5.4%) MACE in total with seven (6.4%) in the PMI group and 39 (5.2%) in the non-PMI group (p=0.6). Kaplan-Meier survival curves were used to estimate 1-year MACE-free survival for the patients with PMI versus non-PMI and there was no significant difference. On multivariable Cox proportional hazards analysis, contrast volume >150 mL, prior coronary artery bypass graft and estimated glomerular filtration rate <60 (mL/min/1.73 m²) were independent predictors of MACE during 1-year follow-up, whereas PMI was not an independent predictor.

Conclusions: PMI defined according to the Fourth Universal Definition of MI and using hs-Tn was common, occurring in 12.8% of patients, but not independently predictive of MACE in 1 year. As PMIs are increasingly used as a component of composite primary end points in major, practice-changing trials, establishing a clinically relevant definition of PMI is of utmost importance.

Background: Untreated severe heart valve disease (HVD) is associated with premature mortality. Research shows low population awareness of when to seek assessment and low focus on cardiac auscultation by physicians in primary care settings. We studied contemporary public knowledge of HVD and assessment by their general practitioner (GP) in Australia.

Method: A total of 1,041 Australians >60 years of age participated in an online survey via the YouGov platform. The results were compared with data collected in 2020 using a similar approach. In addition, in-depth online interviews with 10 GPs were conducted.

Results: The top health concerns were cancer (29.7%), heart attack (14.6%), and Alzheimer's disease (14.3%), and only 2.4% rated HVD as a major health concern (in 2020: 1.4%; p<0.001). HVD could be explained by 17.1% of respondents, with 29.3% being aware of aortic stenosis (in 2020: 17.3%; p<0.001). The majority of Australians >60 years of age reported being socially and physically active on a regular basis. A total of 41.6% of respondents had a cardiac auscultation rarely or never performed by their GP (in 2020: 37.1%; p<0.001). Although GPs were confident with detecting the presence of a murmur, they were not confident to diagnose HVD without further investigation by a cardiologist.

Conclusions: The knowledge and concern about HVD are low among Australians >60 years of age. Large gaps remain including the need for simple, cost-effective strategies to improve patient education to seek routine medical care, promote regular auscultation within primary care, and request echocardiography if clinical suspicion of HVD is present.

Background: Glucagon-like peptide-1 receptor agonist (GLP-1RA) therapies are increasingly used for the treatment of type 2 diabetes mellitus and obesity. Despite growing awareness of potentially increased risk of pulmonary aspiration due to delayed gastric emptying, the risks and benefits of their perioperative use in patients undergoing cardiac procedures remains unexplored. A scoping review was performed to investigate the perioperative GLP-1RA use in patients undergoing cardiac procedures and recommendations.

Method: PubMed and Ovid MEDLINE were searched up to April 2024 to identify English-language studies on the perioperative use of weekly and daily dosed GLP-1RAs in adult patients undergoing cardiac procedures (including cardiac surgery, trans-oesophageal echocardiograms, and cardiac catheterisation procedures).

Results: Three studies were identified, which investigated daily dosed GLP-1RAs in patients undergoing cardiac surgery. No studies were found investigating GLP-1RA use in cardiac catheterisation or trans-oesophageal echocardiograms procedures, and none which specifically examined risk of pulmonary aspiration in patients using GLP-1RAs undergoing cardiac procedures.

Conclusions: GLP-1RAs are beneficial for perioperative weight loss, glycaemic control, and cardiovascular health. Existing guidelines and consensus recommendations are highly contradictory on perioperative GLP-1RA management. Although no known published case reports exist to date of pulmonary aspiration in patients using GLP-1RAs undergoing cardiac procedures, non-cardiac surgical literature strongly suggests that patients are at theoretical risk and a cautious approach is advised in the absence of robust evidence informing recommendations for optimal withholding periods.

Diabetes is becoming more common worldwide, and people with diabetes are twice as likely to experience heart problems compared to those without diabetes. These cardiovascular complications are the foremost cause of mortality among people with diabetes. A specific form of heart failure known as "diabetic cardiomyopathy" can develop in individuals with diabetes. There are no treatments specifically approved for diabetic cardiomyopathy. Ongoing research is exploring innovative treatments, including the development of gene therapy (e.g., adeno-associated viral vectors) techniques designed to target specific molecular pathways affected in the disease. Here, we discuss the progress, challenges, and experimental considerations of gene therapy for the diabetic heart.